Well over 30 years ago, as a raw PG-1 on my first month in the ED, I happened to walk into the room of a 75-year-old woman who had been admitted for CHF on the previous shift by one of our residents. She had been there long enough to earn a lunch tray, which in Tucson often included pinto beans. I must have startled her as she was swallowing because suddenly she grabbed her throat and opened her mouth, unable to talk. Now just to date myself, the Heimlich maneuver was first published in a June 1974 informal article in Emergency Medicine entitled Pop Goes the Cafe Coronary. It wasn’t well known or accepted.

For perspective, the Washington Manual still listed rotating tourniquets as treatment for CHF (if the leeches were unavailable). Despite my momentary asystole, I anticipated having to put her over my knee and smack her back. On the plus side, we didn’t worry much about CPT codes, which didn’t quite cover that exact maneuver. Anyway, she spontaneously launched a pinto bean onto her bed and recovered nicely, thanks to what I’d like to think was my telekinetic powers.

Fast-forward to 10 years ago at the annual Hospice Volunteer Banquet, sponsored by the hospital.

That year, my wife had donated time to visiting hospice families, delivering medicines, and all the other things these volunteers do to help the family make it through the death experience. Our group, like about 20 others, was at a long picnic table mixed with other volunteers, some hospice nurses, and families of former and current hospice patients.

Through the appetizer of shrimp cocktail and the spinach salad, the group shared heartwarming stories of compassionate support. During the steak entrée, I suddenly noticed the large ballroom get quiet and several people at my table pointing over my shoulder at a table way across the ballroom.

There stood a gentleman in his 60s with his hands clasped over his throat and his mouth agape. The room seemed to be frozen like some photographing god had just told them to say cheesesteak. That is, except for the two hospice nurses attending to him by stroking his arms and appearing to offer him comfort. Being an experienced ED doctor had given me a freedom from caution when facing these types of situations. I ran over to his table, assessed his airway obstruction, and quickly applied the Heimlich maneuver.

A chunk of steak the size of an AA battery was catapulted 3 feet out of his mouth, landing between the carrots and smashed garlic potatoes on the plate of an astonished young woman wearing a hospice nurse badge. After assuring myself that the man was now OK, I went back to my now-cold dinner. I gained two life lessons from this event:

• Study and practice had given me the skill and confidence to effectively deal with medical crises.
• Never have a life-threatening episode at a hospice event, unless you are prepared for comfort care.

In our quarterly column (below), we offer recommendations on the unique aspects of treatment during pregnancy. Often, the medical aspects of dealing with drug-abusing pregnant patients are dwarfed by the ethical and legal issues. Many an EP feels a mix of antipathy and sympathy for women who are putting themselves and their unborn children in harm’s way.